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Site Plan Application with narrative September 14, 2020 Mr. Craig Brown, Zoning Administrator Town of Queensbury The Ranch:Zoning Board of Appeals and Site Plan Review Applications Mr. Brown, Our client is requesting the proposed area variances for the recently purchased residence located on 19 Lockhart Loop, Lake George, NY 12845.We have subsequently been hired as the Designer and are providing the following narrative and drawings to compliment the Zoning and Planning Applications.The client wishes to add two porch additions 81.4 sf entry porch and 224 sf Screened porch as well relocate the existing driveway. Please see the narratives below responding to the application inquires for those sought variances: A.The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan. We believe the project is consistent with the Policies of the Town's Comprehensive Plan B.The proposed project complies with all other requirements of this Chapter,including the site plan review standards as set forth in Paragraph F of this section,the dimensional, bulk and density regulations of the zoning district in which it is proposed to be located (Article 3 and Table 1),the applicable requirements of all other Articles that apply. The Site has existing non-conforming structures and a variance is required for the Porch additions. Both the proposed entry and three season porch do not extend further than the existing non-conforming structures within the setbacks. C.The site plan encourages pedestrian activity internally and, if practicable,to and from the site with pedestrian paths or sidewalks connected to adjacent areas. Not Applicable D.The site plan must conform to Chapter 136 Sewage and Sewage Disposal,Chapter 147 Stormwater Management Local Law,and other applicable local laws. The existing private Septic system conforms and is to remain.The current structure is a two bedroom residence and the renovations consist of two proposed bedrooms. E.The proposed use shall be in harmony with the general purpose or intent of this Chapter, specifically taking into account the location,character and size of the proposed use and the description and purpose of the district in which such use is proposed,the nature and intensity of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on supporting public services and facilities which will follow the approval of the proposed use. The proposed use remains the same as the existing single family home.The proposed additions wish to minimize impact on the existing site and character of the surrounding area by only requesting enough square footage for use of the exterior porch and entry porch.The house is supported by a private septic and private well; and will not increase the burden on public services. F.The establishment, maintenance and operation of the proposed use will not create public hazards from traffic,traffic congestion or the parking of vehicles and/or equipment or be otherwise detrimental to the health,safety or general welfare of persons residing or working in the neighborhood or to the general welfare of the town. Traffic access and circulation, road intersections, road and driveway widths and traffic controls will be adequate. The proposed relocation of the driveway will not increase traffic. A sight line of+/-250ft is maintained to the south-west of intersection between Lockhart Loop and NYS Route 9L G. Off-street parking and loading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either undeveloped or previously developed without having made provision for future linkage,then a future connection must be identified and provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties. Not Applicable H.The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological, wildlife, historic, recreational or open space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by the project,taking into account the commercial, industrial, residential, recreational or other benefits that might be derived from the project. In making the determination hereunder,the Planning Board shall consider those factors pertinent to the project contained in the development considerations set forth herein under§ 179-9-080 of this Chapter,and in so doing,the Planning Board shall make a net overall evaluation of the project in relation to the development objectives and general guidelines set forth in§ 179-9-080 of this Article. The goal of the project is to incorporate storm water measures which currently do not exist,with additional plantings and rain gardens, which will add native plants and mitigate storm water runoff from the property and state Route 9L.The owner also intends to relocate the existing driveway as the current driveway discharges storm-water onto Lockhart Loop.The client wishes to slowly introduce more landscaping and plantings to naturalize the existing site.Since the purchase of the lot the client has planted +/-90 native trees. I.The provision for and arrangement of pedestrian traffic access and circulation,walkway structures, control of intersections with vehicular traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent sites shall be provided to encourage pedestrian use. Not Applicable J.Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows.Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter 147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable. Additional Raingardens and plantings are currently under development.As previously mentioned the client's intention is to naturalize the site and treat all stormwater on site and correct any runoff issues which currently exist in an effort to mitigate impact on adjacent sites and Lake George. K.The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by Department of Health regulations and Chapter 136 of the Town Code. The existing private Septic system conforms and is to remain.The current structure is a two bedroom residence and the renovations consist of two proposed bedrooms.The Well elevation is located higher than the septic system and meets all required distances. L.The adequacy,type and arrangement of trees,shrubs and other suitable plantings, landscaping and screening shall effectively provide a visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetation and maintenance, including replacement of dead or deceased plants. As previously mentioned the client's intention is to naturalize the site.Additional plantings will be provided to buffer adjacent lots. Retention and maintenance of all plants will be consistent. M. Fire lanes,emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers. Provided. N.The design of structures, roadways and landscaping in areas susceptible to ponding,flooding and/or erosion will minimize or avoid such impacts to the maximum extent practicable. Provided, refer to site plan. O.The site plan conforms to the design standards, landscaping standards and performance standards of this chapter. Provided, refer to site plan. Thank you for your consideration in this matter. Sincerely, Trevor Flynn RA General Information Tax Parcel ID Number: 239.18-1-22 Zoning District: RR-5A-Rural Res 5 Ac Lot size: 1.84 Detailed Description of Project [includes current&proposed use]: The owner is proposing to to rennvate the existing 1 ctnry cin• e family dwelling and add two pnrch additinnc The owner alcn intends to relocate the existing driveway as the current driveway discharges storm-water onto Lockhart Loop. The Clients goal is to slowly build up the natural surrounds of the site with more plantings,to create a more natural wooded aesthetic. Location of project: 19 Lockhart Loop,Lake George,NY 12845 Applicant Name: Trevor Flynn Address: 78 Lake Desolation Rd,Middle Grove Home Phone Cell: Work Phone 518-396-9624 Fax E-Mail: Trevorcflynn@gmail.com Agent's Name: Address: 78 Lake Desolation Rd,Middle Grove Trevor Flynn Home Phone Cell: Work Phone Fax 518-396-9624 E-mail Trevorcflynn @ gmail.com Owner's Name Address 4 Lockhart Loop,Lake George NY James S Denooyer Home Phone Cell 518-260-5577 Work Phone Fax E-mail Lolode@aol.com 2 Site Plan Review application—Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 Site Development Data Area/Type Existing sq.ft. Proposed Total sq. ft. Addition sq. ft. A. Building footprint 1,594 1,594 B. Detached Garage 1,020 1,020 C. Accessory Structure(s) D. Paved, gravel or other hard surfaced area 4,482 1,157 5,639 E. Porches/Decks 306 306 F. Other 397 213 610 G. Total Non-Permeable [Add A-F] 7,493 1,676 9,169 H. Parcel Area [43,560 sq. ft./acre] 80,150.4 I. Percentage of Impermeable Area of Site [I=G/H] 9.5 11.4 Setback Requirements Area Required Existing Proposed Front [1] 100 70 56.5 Front [2] 100 76 No Change Shoreline NA - - Side Yard [1] 75 - - Side Yard [2] 75 - - Rear Yard [1] 100 - - Rear Yard [2] 100 - - Travel Corridor NA Height [max] 35 17 No Change Permeability 75 90.5 88.6 No. of parking spaces 2 2 2 3 Site Plan Review application—Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 Additional Project Information 1. Will the proposal require a Septic Variance from the Town Board of Health? NO 2. If the parcel has previous approvals, list application number(s): 3. Does this project require coverage under the New York State Pollutant Discharge Elimination System (SPDES) Permit Program ? No 4. Estimated project duration: Start Date 10/1/20 End Date 6/1/21 5. Estimated total cost of project: 50,000 6. Total area of land disturbance for project: 11,992 SF Floor Area Ratio Worksheet FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building floor area by the lot size in square feet, yielding a percentage. Zoning District Symbol Floor Area Ratio [FAR] Waterfront Residential WR 0.22 Commercial Moderate/Intensive CM/CI 0.3 A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height and covered porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending over water and one storage shed of one hundred twenty (120) square feet or less. Any additional sheds will be included. (See "FLOOR AREA RATIO"). B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a building or structure, and when applicable, the sum total of all floor areas of the principal and accessory buildings or structures on the project site. A. Parcel Area 80,150.4 sq. ft. B. Existing Floor Area 1,594 sq. ft. [see above definition] C. Proposed Additional Floor Area 306 sq. ft. D. Proposed Total Floor Area 1,900 sq. ft. E. Total Allowable Floor Area 17.633 (Area x .22 ) [see above table] *If D is larger than E. a variance or revisions to your plan may be needed. Consult with Staff. 4 Site Plan Review application-Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 § 179-9-080 Requirements for Site Plan Approval. The Planning Board shall not approve a Site Plan unless it first determines that such site plan meets the following Standards. Please prepare responses to each of the following topics: STANDARDS A. The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan. B. The proposed project complies with all other requirements of this Chapter,including the site plan review standards as set forth in Paragraph F of this section,the dimensional,bulk and density regulations of the zoning district in which it is proposed to be located(Article 3 and Table 1),the applicable requirements of all other Articles that apply. C. The site plan encourages pedestrian activity internally and,if practicable,to and from the site with pedestrian paths or sidewalks connected to adjacent areas. D. The site plan must conform to Chapter 136 Sewage and Sewage Disposal,Chapter 147 Stormwater Management Local Law,and other applicable local laws. E. The proposed use shall be in harmony with the general purpose or intent of this Chapter,specifically taking into account the location, character and size of the proposed use and the description and purpose of the district in which such use is proposed,the nature and intensity of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on supporting public services and facilities which will follow the approval of the proposed use. F. The establishment,maintenance and operation of the proposed use will not create public hazards from traffic,traffic congestion or the parking of vehicles and/or equipment or be otherwise detrimental to the health,safety or general welfare of persons residing or working in the neighborhood or to the general welfare of the town. Traffic access and circulation,road intersections,road and driveway widths and traffic controls will be adequate. G. Off-street parking and 19oading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers the Town's goal of reducing curb cuts and reducing congestion. A twenty-foot wide connection is required. If adjacent properties are either undeveloped or previously developed without having made provision for future linkage,then a future connection must be identified and provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties. H. The project shall not have an undue adverse impact upon the natural,scenic,aesthetic,ecological,wildlife,historic,recreational or open space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by the project,taking into account the commercial,industrial,residential,recreational or other benefits that might be derived from the project. In making the determination hereunder,the Planning Board shall consider those factors pertinent to the project contained in the development considerations set forth herein under§ 179-9-080 of this Chapter,and in so doing,the Planning Board shall make a net overall evaluation of the project in relation to the development objectives and general guidelines set forth in§ 179-9-080 of this Article. The provision for and arrangement of pedestrian traffic access and circulation,walkway structures,control of intersections with vehicular traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent sites shall be provided to encourage pedestrian use. J. Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre-development drainage flows. Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off-site shall not degrade any streams or adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter 147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable. K. The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by Department of Health regulations and Chapter 136 of the Town Code. L. The adequacy,type and arrangement of trees,shrubs and other suitable plantings,landscaping and screening shall effectively provide a visual and/or noise buffer between the applicants and adjoining lands,including the maximum retention of existing vegetation and maintenance,including replacement of dead or deceased plants. M. Fire lanes,emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers. N. The design of structures,roadways and landscaping in areas susceptible to ponding,flooding and/or erosion will minimize or avoid such impacts to the maximum extent practicable. O. The site plan conforms to the design standards,landscaping standards and performance standards of this chapter. 5 Site Plan Review application—Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 § 179-9-050 Checklist-Application for Site Plan Review. Application materials and site plan shall include sufficient information for the Board to review and provide a decision. The applicant is to provide a site plan drawing and all attachments that address items A-V. The applicant may request a waiver from A-V and is to provide reasons for waiver(s) requested. Please label information to be submitted. REQUIREMENTS Sheet# A. A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect or serve it,such as roads,shopping areas,schools,etc. The map shall also show all properties,identify owners, Site Plan subdivisions,streets and easements within 500 feet of the property. Such a sketch may be superimposed on a United States Geological Survey map of the area. B. The site plan shall be drawn at a scale of forty feet to the inch(1"=40 feet)or such other scale as the Planning Board may deem appropriate,on standard 24"x 36"sheets,with continuation on 8 1/2"x 11"sheets as necessary for written Site PLan information. The information listed below shall be shown on the site plan and continuation sheets. C. Name of the project,boundaries,date,north arrow,and scale of the plan. Site Plan, D. Name and address of the owner of record,developer,and seal of the engineer,architect or landscape architect. If the applicant is not the record owner,a letter of authorization shall be required from the owner. Attached E. The location and use of all existing and proposed structures within the property,including all dimensions of height and floor area,all exterior entrances,and all anticipated future additions and alterations. Site Plan F. The location of all present and proposed public and private ways,off-street parking areas,driveways,outdoor storage areas, sidewalks,ramps,curbs,paths,landscaping,walls and fences. Location,type and screening details for all waste disposal Site PLan containers shall also be shown. G. The location,height,intensity and bulb type(sodium,incandescent,etc.)of all external lighting fixtures. The direction of NA illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with§ 179-6-020. H. The location,height,size,materials and design of all proposed signs. NA I. The location of all present and proposed utility systems including: Site plan 1. Sewage or septic system; 2. Water supply system; 3. Telephone,cable and electrical systems;and 4. Storm drainage system including existing and proposed drain lines,culverts,catch basins,headwalls,endwalls, hydrants,manholes and drainage swales. J. Plans to prevent the pollution of surface or groundwater,erosion of soil both during and after construction,excessive runoff and flooding of other properties,as applicable. A Stormwater Pollution Prevention Plan(SWPPP)for all land development Site Plan activities(excluding agricultural activities)on the site that results in land disturbance of one acre or more. A SWPPP shall comply with the requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury Code. It shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be required for a site plan review project land disturbance of less than one acre. K. Existing and proposed topography at two-foot contour intervals,or such other contour interval as the Planning Board shall allow. All elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel Site Plan is within the 100-year floodplain,the area will be shown and base flood elevations given. Areas shall be indicated within and planting plan the proposed site and within 50 feet of the proposed site where soil removal or filling is required,showing the approximate volume in cubic yards. L. A landscape plan showing all existing natural land features than may influence the design of the proposed use such as rock outcrops,stands of trees,single trees eight or more inches in diameter,forest cover and water sources and all proposed Planting changes to these features,including sizes and types of plants. Water sources include ponds,lakes,wetlands and Plan watercourses,aquifers,floodplains and drainage retention areas. M. Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan,as well as any Overlay Districts that apply to the property. NA 6 Site Plan Review application—Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 • REQUIREMENTS (CONTINUED) Sheet# N. Traffic flow patterns within the site,entrances and exits,loading and unloading areas,as well as curb cuts on the site and NA within 100 feet of the site. The Planning Board may,at its discretion,require a detailed traffic study for large developments or for those in heavy traffic areas,which shall include: 1. The projected number of motor vehicle trips to enter or leave the site,estimated for weekly and annual peak hour traffic levels; 2. The projected traffic flow pattern including vehicular movements at all major intersections likely to be affected by the proposed use of the site; 3. The impact of this traffic on levels of service on abutting public streets and at affected intersections. Existing and proposed weekly and annual peak hour traffic levels and road capacity levels shall also be given. O. For new construction or alterations to any structure,a table containing the following information shall be included: NA 1. Estimated area of structure to be used for particular purposes such as retain operation,office, Storage,etc.; 2. Estimated maximum number of employees; 3. Maximum seating capacity,where applicable;and 4. Number of parking spaces existing and required for the intended use. p. 1. Floor Plans. See Plans 2. Elevations at a scale of one-quarter inch equals one foot(1/4"=1 foot)for all exterior facades of the proposed structure(s) and/or alterations to or expansions of existing facades,showing design features and indicating the type and color of materials to be used. Q. Soil logs,water supply well and percolation test results,and storm water runoff calculations as needed to determine and mitigate project impacts. Site Plan R. Plans for disposal of construction and demolition waste,either on-site or at an approved disposal facility. NA S. Plans for snow removal,including location(s)of on-site snow storage. NA T. An Environmental Assessment Form("EAF")as required by the SEQRA regulations,with Part 1 completed by the Applicant Part 1 shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been submitted in conjunction with a special use permit application,a duplicate EAF is not required for the site plan application. U. If an application is for a parcel or parcels on which more than one use is proposed,the applicant may submit a single NA application for all such uses,provided the proposed uses are accurately delineated on a site plan drawn pursuant to the requirements set forth above. The Planning Board may grant the application with respect to some proposed uses and not others. For purposes of reviewing an application(and for SEQRA compliance)all proposed uses on a single parcel or on contiguous parcels shall be considered together. V. A brief narrative statement on how the project proposed for review furthers or is consistent with the vision,goals and policies in the Town's Comprehensive Plan. attached 7 Site Plan Review application—Revised October 2016 Town of Queensbury Planning Office-742 Bay Road,Queensbury,NY 12804 • Town of Queensbury Site Plan Pre-Submission Conference Form / Section 179-9-040 1. Applicant Name: Trevor Flynn/D Q f 19G yye I 2. Tax Map ID 239.18-1-22 Location:? 19 Lockhart Loop 3. Zoning Classification RR-5A 4. Reason for Review: ✓le.'.-LA�C'X:I-ect-e.: iYt Ct C EA " (, i"t -t-ewer echo, f fy tour c-C'( 5. Zoning Section#: 1 7 cl-C9`U(u5 keJ-kt' ( `ca q rY. '"�t P�2(II 01C�(T(,UO S CAt SeC-f c1cvc. ,..c.Cl_� dCtr4 Se,c CthO4S 6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by re"OC c-h Gn Deed /9(Gkc tie(Vt./ General Information complete �, �«� pz 0 C-i`e.� Site Development Data Complete f Setback Requirements Complete k)1A-Ft't,Evt4 c6k-CACc'"4-,\ e„Lt el LicU/1 Additional Project Information Complete ,i Get "� 't t t-e pG t e_ FAR addressed ,`a'1k FrO7 t 1 4.1 a.11Gq Requirements for Site Plan-Standards f✓. Checklist items addressed 1C 0L, Cgc,/C WT Environmental Form completediL e S d.c ,4c)t'4e r..ifvIe(* Lad Signature Page completed V A p p(t Cc/,+ P(L , 5e, +tA)0 p 0 c-c c cAzt et, 4 i v./tS- ft k c-t 4 4 Y C'OJv-e cA e.kk--c14 rrbc'(,�� �aa < e cZ`(-1 'Q'6'4 �ac�r( I. srJo k-o=l otclriktec t p1- f� G o (lc) f 4 r- Ckc Qc hcvtS ( G pc�,�-i D &tcec► a`Zn t-ScAr e,.( fC L-r d— fit L`F t GI E ct &cort pc, 610 G(`P c-k 24):.PC.j` Sj: e C 4? Si C k.4.f--�) C M 1 G'�( c'/L Cc C L'%( e) , S(c 4/(0.14(17)/Af(gr, ,S14(cc L4, ro et, - s` ,e cet vcr(o('e p +-IG=c1c cF 201-e et 56, `--‘ ,..Oh zee. ct(t.)C- -t S. t ele t,, r-4 fi( ,?v _SC N e4 pc-c Li .- Pi-C-rd ,ek-tr e-OS_ 6-3 C:t -e teck ', y 1►rd4jo C1L 4 4e/Lf� t2')ui c Cr )Dda . cl '✓t(.fcc� t rD _ (k c�cc--c,, Ck.�c Y t9\hvt< - ('� 1- COf 1 0 'y Yy rt•tfs ? tv v`�� c;(10"- `-,'6c-4- c,- I'le,tct titi- eke,n(t ew, #14-e Al t,.)CIO I/aer ..A(SC t..L., &-~ea j/Se-4 �CC.s - pi rc(A c,reci h) eiz_ ._a(o v,t�2 c!,..k_ pf.'�5(Oa S el r tttc; 3iv't(/aG,e 1CS- a!( t ru44-, Staff Representative: k V rt, kkaA._Val c, .P NtC4 t Applicant/Agent: Date: -. ' -;-- (212CD 3 ',4 I-eC! i (it ` 5 sile ; L `k-,t--ia sIr ;, be 4rttraSec- E5y , Si( -Ihe. I�' 'j�e6-S. c,ce. -fyficc [Icr ipe:/i no iea .f kt4c U Site Plan Review application—Revised October 2016 tvc'A EA F 8 y_ Town of Queensbtry Planning OffRe-742 Bay Road,Queensbury,NY 12804 -0- �j'�, ,� V'�-Pl►'tG t �r pct'. 'tell(c�Ct`tV!1 &..tc, # t e wjr 4 fipuccItrr'n i Area Variance [ZBA approved: September 21 2016] This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.)Authorization for Site Visits; 4.) Other Permit Responsibilities;5.)Official Meeting Disclosure and 6.)Agreement to provide documentation required. OWNER'S AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant: Owner: James S DeNooyer Designates:Trevor Flynn as Agent regarding the following: Variance X Site Plan X Subdivision For Tax Map No.:239:18-1-22 Deed Reference: Book569� Page 316 Date 1/9/18 OWNER SIGNATURE: DATE: 8/11/20 APPLICANT'S AGENT FORM: Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party: Owner: James S DeNooyer Designates: Gerald R Flynn as Agent regarding the following: Variance X Site Plan X Subdivision For Tax Map No.:239-18-1-22 Deed Reference: Book569: Page 316 Date 1/9/18 OWNER SIGNATURE: f' DATE: 8/11/20 2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic design, storm drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant. Fees for engineering review will not exceed$ 1,000 without notification to the applicant. 3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the Owner,Applicant,and his/her/their agent(s)hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of reviewing the application submitted. 4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits. 5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes the official record of all proceedings. 6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the application,plans and supporting materials are a true and complete statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed,I or my agents, will obtain a certificate of occupancy as necessary. I also understand that I/we may be required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy I havr_, a --a .w,.above. Trevor Flynn 08/11/20 Sign; Print Name[Applicant] Date signed Trevor Flynn 08/11/20 Signature[Agent] Print Name[Agent] Date signed Page 7